Center of Excellence in Cancer Communication Research

CECCR I Pilot Projects

Antismoking Public Service Announcement Evaluation Study

Yahui Kang, PhD

The primary task of this research was to expand our understanding of the antismoking ads features and to gather data about how these ad features may influence the effectiveness of these ads on smokers. This study was conducted as an online survey by Knowledge Networks, an external research firm. Participants were adult smokers randomly selected by Knowledge Networks across the nation. About 400 adult smokers viewed a random selection of 4 ads from a pool of 32 ads on their computer screen or television at home. These 32 ads included ads with no smoking cues, ads with weak smoking cues (i.e. presence of cigarettes) and ads with strong smoking cues (e.g. actual smoking behavior). After viewing each ad, participants rated the ad in terms of the transportation capacity, visual verbal redundancy, emotional impacts and perceived effectiveness of the ad. These self-report measures of ad features not only helped us understand how smokers evaluate anti-smoking messages, especially those with smoking cues, but also served as important criteria for future ad selection in cue-reactivity studies.

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Cancer Mass Media Communication about Survival and Death

Jessica Fishman, PhD, Katrina Armstrong, MD, MSCE, David Casarett, MD, MA, Robert Hornik, PhD

Prior research on patient decision making has shown that patients making choices about their cancer care are influenced by information pertaining to treatment side effects, effectiveness and chance of survival. Because African American and Caucasian cancer patients have different preferences for cancer care, we will investigate the potential contribution of relevant information provided by news media coverage of cancer treatments and outcomes.

This pilot focuses on the cancer news reporting provided by national magazines. The aim of this project is to compare the proportion of cancer-focused articles in “mainstream” and African American-targeted magazines that report on cancer treatment side effects, treatment effectiveness, survival, and death. This project contributes to a line of research designed to investigate whether cancer care preferences linked to end-of-life disparities are associated with African American and Caucasian exposure to and perceptions of cancer news coverage. Ultimately, the findings will be used to gain a better understanding of the relationship between cancer media exposure and patients' clinical cancer care preferences. This research will aid our investigation of factors influencing patient treatment decisions that are linked to racial/ethnic disparities in late-stage cancer care.

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Cancer-Related Information Seeking and Scanning Behaviors among Vietnamese Immigrants

Giang T. Nguyen, MD, MPH

This pilot project is an extension of the larger Information Seeking and Scanning study. Researchers performed 20 semi-structured interviews with Vietnamese immigrants, ages 50-70, using bilingual, bi-cultural research assistants to conduct the interviews in the native language of the participants. Questionnaires used for this study are an adapted version of the instrument used for the general population in the Information Seeking and Scanning study. In addition to assessing and identifying themes related to sources of cancer-related information, researchers are exploring the interplay between mainstream and ethnically specific media sources and its impact upon individual decision-making. Preliminary findings show that older Vietnamese immigrants in this study report a fairly limited number of cancer information sources. Frequently mentioned sources include Vietnamese newspapers and interpersonal communication with friends and family. Physicians appear to be a trusted source of information, but study participants did not generally report a history of seeking information from their doctors. Internet use is extremely limited in this population.

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Effects of Benefit-Target Framing on Intentions to Engage in Health Behaviors

Bridget Kelly, MPH, PhD

Many health officials believe the future of public health is in prevention of infectious disease, due to threats like SARS, avian influenza and pandemic flu and even viruses that can cause cancer, such as the Human Papillomavirus. In June 2006, the FDA approved the first vaccine to prevent cervical cancer. Within the next year, a second vaccine, called Cervarix, is expected to receive approval. However, it is unclear what kind of impact the vaccines will have on the virus, as adult vaccine compliance has historically been low. As a result, vaccine promotion is becoming an increasingly important area for health communication researchers. One strategy health promoters can consider is to emphasize the message that getting vaccinated not only protects the person receiving the immunization, but also loved ones, and even unknown others to whom the disease could be spread. The set of experiments described here tested whether such a strategy (called “benefit-target framing”) could prove useful in promoting vaccine intentions.

The first study randomized participants to receive a message about how getting vaccinated could protect either their own health, their loved ones’ health or the health of others they may not know. These messages were tested in the contexts of the avian flu and HPV vaccines. A second study tested mediators and moderators of the effects in the avian flu context. A third experiment attempted to replicate the effects in the area of obesity prevention.

Findings suggest that for avian flu, the society messages (or those about unknown others) resulted in higher intentions than both messages about the self and those about loves ones. Results of the experiments reveal that the effects of benefit-target framing vary sharply across health topic and among groups with different demographic and personal experience characteristics. For example, for HPV, effects only occurred for single men, while in the obesity context, people who were not already engaging in regular exercise were more susceptible to other-oriented messages. In the avian flu context, past behavior, age and education were moderators. There is evidence from the mediation analyses that the effects of benefit-target framing on intentions are mediated through two opposite paths, as the society messages produced both more elaborate processing, which resulted in higher intentions than the self group, and lower levels of perceived risk, which resulted in lower intentions. Possible explanations for the findings, as well as implications for future research are discussed.

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Effects of Threat-Oriented and Efficacy-Oriented Antismoking Ads on Adult Smokers’ Intentions to Quit

Norman C. H. Wong, PhD, J.N. Cappella

his study examined the effects of sequencing different types of antismoking threat and efficacy (i.e., cessation-oriented) appeals on smoking cessation intentions for smokers with low and high levels of readiness to quit. An experiment was done to test predictions based on Witte’s (1992) Extended Parallel Process Model and recent work by Cho and Salmon (2006) that suggests fear appeals may work differently for people in different stages of change. A national probability sample of 555 adult smokers was recruited to take part in this study. Participants were randomly assigned to 1 of 5 ad viewing conditions: (a) 2 high threat antismoking ads & an ad for the nicotine patch, (b) 2 high threat antismoking ads & an ad promoting the use of a national quit line, (c) 2 low threat antismoking ads & an ad for the nicotine patch, (d) 2 low threat antismoking ads & an ad promoting the use of a national quit line, and (e) 2 high antismoking threat ads only. Results found the expected positive two-way interaction effect between message threat and perceived message efficacy on intentions to seek help for quitting. Specifically, intentions to seek help for smoking cessation was only high when both threat and efficacy perceptions were high, otherwise intentions were low. For intentions to quit smoking, a three-way interaction effect was found between message threat, perceived message efficacy, and readiness to quit. Specifically, for smokers with low readiness to quit, intentions were high only when both threat and efficacy perceptions were high. But for smokers with high readiness to quit, although both threat and efficacy perceptions were important predictors of quitting intentions, perceived message efficacy was a significantly stronger predictor than message threat. The results of this study has two important implications for designers of health campaigns aimed at promoting greater smoking cessation among adults. First, both high threat-oriented and high efficacy-oriented information need to be present for smoking cessation messages to be most effective at motivating quitting. Second, smokers’ level of readiness to quit may serve as an effective way to segment the audience for future antismoking campaigns, such that tailored messages could be given to smokers at different readiness to quit levels.

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Evaluation of Quest Cigarette Advertisements

Caryn Lerman, William Shadel, Andrew Strasser

The goal of this study is to explore how smokers perceive Quest, low nicotine cigarettes, advertisements. The ultimate objective is to determine whether beliefs about Quest cigarettes correlate with quitting intentions. This study evaluated health beliefs and perceptions about Quest cigarettes following exposure to a single print advertisement among 200 participants in states where Quest cigarettes are not marketed or available. Participants made several false inferences about Quest cigarettes after exposure to the advertisement (i.e., lower in tar, healthier, less likely to cause cancer). The prevalence of particular false inferences was significantly greater among smokers who had less than a high school education. Two individual difference variables, need for cognition (i.e., enjoy thinking about complex issues) and perceived vulnerability (i.e., personal risk for smoking-related disease), moderated smokers' health beliefs about Quest cigarettes. A manuscript with results from this study was recently published in Psychology of Addictive Behaviors.

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Exploring Individual Eye Movement Patterns When Viewing Smoking Cessation Public Service Announcements

Deborah Linebarger, PhD

This study will test the effects of message sensation value (MSV) in anti-tobacco public service announcements (PSAs) on an individual’s eye movement patterns. Participants will view PSAs that vary in their message sensation value, as well as their visual/verbal redundancy. Eye tracking equipment will be used during viewing to determine where the individual fixates on the screen, duration of fixation and when these fixations occur during the PSA. Analysis of this data will allow researchers to examine the stimuli that are related to these fixations and durations as well as help researchers determine the impact of MSV and visual/verbal redundancy on eye movement patterns. In addition to reviewing the individual characteristics of the PSAs on eye movement patterns, this study will investigate how individual characteristics of the viewer may influence these patterns. Researchers are particularly interested in understanding how an individual’s appetite-aversive trait (positivity offset/negativity bias or PONB) may influence these eye movement patterns. This study will investigate the potential relationship between an individual’s PONB and eye movement while viewing a smoking cessation PSA. Further, it will allow researchers to determine if visual/verbal redundancy and/or message sensation value differentially influence eye movement as a function of PONB.

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Functional MRI of Brain Response to Anti-Smoking Advertisements

Daniel Langleben, MD

This is a pilot study for the larger center project titled Evaluating Anti-Tobacco public service announcements (PSAs). The purpose of this study is to evaluate the feasibility of using functional Magnetic Resonance Imaging (fMRI) to study brain response to anti-smoking PSAs. In preliminary studies, researchers used perfusion fMRI to detect increased activity in the components of the brain limbic system in opiate-dependent patients in response to a ten-minute heroin-related video. The results indicated that (1) Brain response to media can be measured with fMRI; (2) Brain response to media varies across target audiences and (3) Specific structures mediating strong interest could be activated in the target population but not the controls. Collaborators at Penn have also used fMRI to detect differential response to the emotional image content. This pilot study takes an important first step towards exploring the feasibility of using magnetic resonance signal as a marker of cognitive (e.g. attention) and emotional (e.g. arousal) responses to different PSAs. Results from this would allow interpretation of the brain response to a PSA in terms of known brain localization of cognitive functions.

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Interest in Direct to Consumer Sales for BRCA 1 and BRCA 2 Mutation Testing Among Women with a Family History of Cancer

Stacy Gray, MD, AM

Web-based genetic testing for select cancer susceptibility genes is currently being marketed and sold directly to the public. Direct to consumer (DTC) provision of cancer susceptibility testing has not been extensively studied, and although DTC testing may increase access to indicated tests, it may also be associated with significant risks compared to testing through a physician’s office. The purpose of this pilot project is to elicit beliefs about DTC genetic testing for BRCA mutations among women at increased risk for breast/ovarian cancer and to evaluate the effects of exposure to risk/benefit information for DTC genetic testing on women’s beliefs, perceptions of social norms and intentions to purchase DTC genetic testing. The long term goals of the project are to understand the factors that might motivate high risk women to pursue online testing rather than clinic-based testing and to start to understand how risk/benefit information on DTC genetic testing should be presented to patients online in order for them to be able to accurately evaluate the risks and benefits of DTC BRCA testing. This line of research will help to determine key standards of care that policy makers should consider as they formulate regulations for the DTC industry.

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Marketing Prescription Drugs: A Content Analysis of Television Direct-to-Consumer Advertising

Dominick L. Frosch, PhD, Patrick Krueger, PhD, Robert Hornik, PhD, Frances Barg, PhD

American television viewers see as many as 16 hours of prescription drug advertisements per year, yet no research has examined how television ads attempt to influence consumers. The study attempts to explore the messages embedded in these ads. Ads shown during evening news and primetime were coded for factual information about the target condition, how the ads attempt to appeal to consumers, and portrayals of medication and lifestyle behaviors in the lives of ad characters. Results indicate that despite the claims that prescription drug advertisements serve an educational purpose, they provide limited information about the causes of a disease or who may be at risk; show characters that have lost control over their social, emotional or physical lives without the medication; and minimize the value of health promotion through lifestyle changes.

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Public attitudes of and intentions to vaccinate against Human Papilloma Virus (HPV)

A. Leader, J. Weiner, B. Kelly, J.N. Cappella, R. Hornik

This study developed from an initial proposal awarded in Project Year Three to study the Human Papilloma Virus (HPV) vaccine. In response to the FDA’s approval of the first vaccine against Human Papilloma Virus (HPV), we have undertaken a two part study, making use of the ANHCS survey mechanism. Study 1 tests the effects of alternative frames for understanding HPV vaccination. Study 2 involves creating a baseline for prospective analysis of relevant behavioral and policy beliefs surrounding the HPV vaccine. In Study 1, framing manipulation is achieved by varying the content describing the vaccine. In the study, 635 adults read one of three short descriptive paragraphs about the vaccine, each of which emphasized a different aspect of the vaccine: the vaccine protects against cancer; the vaccine protects against a sexually transmitted disease; the vaccine may or may not lead to increased sexual promiscuity among those vaccinated. Participants were then asked about their intentions to vaccinate under cost or no-cost conditions.

Women who read that the vaccine protects only against cervical cancer had significantly higher intentions to vaccinate themselves when the vaccine was available at little or no cost compared to women who read alternate versions of the descriptive paragraph, F(2,323)=5.74, p=0.004. Intentions to vaccinate female children were mixed, although this could be attributed to insufficient power to detect significant differences. Trends indicate that intentions are highest when the vaccine is framed to solely prevent cervical cancer and lowest when the vaccine is framed to prevent both cervical cancer and an STI, indicating that people may feel the need for an STI vaccine is unnecessary, perhaps due to a false sense of disease risk. Data collection and analysis for Study 2 is ongoing

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Quest Cigarette Ad Manipulation

A. Strasser, PhD

Background: The Institute of Medicine report on potential reduced exposure products (PREPs) recommends that advertising and labeling be regulated to prevent explicitly or implicitly false or misleading claims. Belief that a product is less harmful may increase use or prevent smoking cessation.

Objective: To determine the effect of altering advertisement features on smokers beliefs of the harm exposure from a PREP.

Methods: A Quest advertisement was digitally altered using computer software and presented to participants using web-based television recruitment contracted through a survey company. 500 current smokers completed demographic and smoking history questions, were randomized to view one of three advertisement conditions, then completed eight items assessing their beliefs of the harmfulness of the product. Advertisement conditions included the original, unaltered advertisement; a red condition where the cigarette packages were digitally altered to the color red, implying increased harm potential; and a no text condition where all text was removed to reduce explicit product information. Polytomous logistic regression, using incorrect, unsure and correct as outcomes, and advertisement type and covariates as predictors, was used for analyses.

Results: Participants randomized to the no text advertisement were less likely to be incorrect in their beliefs that Quest cigarettes are lower in tar, less addictive, less likely to cause cancer, have fewer chemicals, healthier and make smoking safer.

Conclusions: Smokers can form false beliefs about the harmfulness of PREP products based on how the PREPs are marketed. Careful examination must be undertaken to provide empirical evidence to better formulate regulatory principles of PREP advertising.

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Sociocultural Impact of Media Coverage of Genetic Risks of Smoking

Chanita Hughes-Halbert, PhD, Oscar Gandy, PhD

The current study is designed to provide preliminary information on psychological and behavioral reactions to media messages about racial differences in genetic risks of smoking in African Americans. A total of 196 African American men and women, ages 18 and older, have been enrolled in the study. A total of 67 men and women participated in focus group discussion sessions aimed at understanding reactions to media messages about race, genetics and smoking. The research completed during the past two years demonstrates that, despite limited endorsement of the influence of genetic factors on smoking initiation and nicotine dependence, most African American smokers would be willing to participate in research designed to identify genetic risk factors for smoking. Our results also suggest that recruitment messages for studies on genetics and smoking behavior may need to address concerns about the limitations and risks for genetic testing for smoking susceptibility. We will complete analysis of qualitative data from the focus group discussion sessions to understand reactions to media messages about race, genetics and smoking. The results from these analyses will be used as preliminary data for an R01 application to evaluate psychological and behavioral responses to targeted recruitment messages for participation in smoking and genetics research among African American smokers.

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Testing Anxiety vs. Health Anxiety: The Consequences for Screening Adherence

Barbara Kahn, PhD

This research, led by Barbara Kahn, PhD, focuses on the effects of generated anxiety on subsequent screening test adherence. Researchers suggest that the hospital waiting room may prime previous testing anxiety that can lead to delay in subsequent testing intentions. This research will investigate the effects of various other kinds of priming manipulations to determine how they might affect testing and general health anxiety. Researchers will explore primes that are promotion-focused, focusing individuals on their hopes, aspirations and nurturance needs versus prevention-focused where people are focused on their duties, responsibilities and security needs. We hypothesize that these different types of priming will affect patients testing anxiety differentially as a function of their false positive history. For patients who have false positive histories, a prevention-focused prime will increase subsequent testing adherence as compared to a promotion-focused prime. For patients with no false positive histories, but rather normal previous screening results, a promotion-focused prime will increase subsequent testing adherence.

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The Impact of Smoking Cues in Anti-smoking Public Service Announcements on Smoking Urge, Message Processing and Intention to Quit Smoking

Yahui Kang, PhD

The primary task of this research was to examine the potentially negative impact of smoking scenes in anti-smoking PSAs on smokers' urge to smoke, cognitive evaluations of anti-smoking PSAs, and intention to quit smoking. A group of adult smokers visited the EPIC CECCR lab at the Annenberg School to watch six antismoking ads. They were randomly assigned to one of two experimental conditions: high versus low argument quality. In each condition, they watched three ads with no smoking cues followed by three ads with smoking cues. Sensors were placed on their palm, arm, and face to measure their physiological reactions (skin conductance, heart rate, and facial electromyography) during the viewing of the ads. Participants' evaluations of the ads as well as intention to quit smoking were also measured. The combination of these two types of measures allowed us to assess the impact of smoking cues at both physiological and psychological levels, and to understand how smoking urge may interfere with one's processing of the anti-smoking arguments in the ads and intention to quit smoking. This study was the first to investigate empirically the effect of PSA smoking cues on physiological and cognitive measures.

the study showed that the smoking-cue ads as a whole (a combination of smoking cues and antismoking arguments) only significantly increased smoking urge in the weak argument condition. Smoking urge is found to be associated with reduced heart rate especially in the weak argument condition, and with reduced skin conductance for certain population. In terms of message processing, smoking cues did not show distraction effects as hypothesized. Stronger antismoking arguments showed a cognitive advantage over weaker arguments on ad learning and self-efficacy over time. Smoking urge was also found to negatively affect self-efficacy of quitting and hence intention to quit smoking. These findings have important policy implications with regard to whether smoking cues should be included in anti-smoking PSAs

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The Nature of Risk Perception and Cancer Screening and Prevention among African-Americans

Oscar Gandy, PhD

This project, led by Oscar Gandy, PhD, focuses on the nature of risk perception among African Americans. The literature on optimistic bias is extensive, but there is very little about optimistic bias among African Americans, and even less that examines the relationship between optimistic bias and health related screening and prevention activities. This project will integrate the literature on health risk perception and related literatures on optimistic bias, third-person effect and racial identity among African Americans. It is identifying relevant data sets, such as the MIDUS [Midlife development in United States] dataset and those made available through the Kaiser Network, that combine health locus of control (HLOC), risk assessment, and cancer screening and prevention. While there is some work being done to explore HLOC among African Americans, including some innovative investigations of religious subscales, there is a need for an integrative analysis of these risk-related literatures that takes African American cultural perspectives into account. Preliminary results suggest that belief in the influence of God may be a factor in HLOC, especially among African Americans. Preliminary analyses of the data collected for Hughes-Halbert's pilot project has examined the ways in which HLOC relates to personal health experience and orientations toward genetic testing. Future analyses will explore how religiosity affects those relationships.

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The relationship between children’s knowledge of persuasive intent and persuasion: The case of televised food advertising

Ariel Chernin, PhD

The marketing of foods high in sugar and fat is viewed as a potential cause of childhood obesity. Researchers and public policy makers have speculated that younger children are especially vulnerable to food advertising because they lack knowledge of persuasive intent; that is, they don’t understand that commercials try to convince people to buy products. Using a sample of 133 children, this pilot study tested the two claims that underlie this argument: (1) children younger than eight years old lack knowledge of persuasive intent, and (2) knowledge of persuasive intent moderates the persuasion process in children. In contrast to early research on children’s understanding of advertising, the results indicated that a majority of children between the ages of five and eleven years old possessed knowledge of persuasive intent. In addition, children’s preexisting knowledge of persuasive intent did not moderate the influence of ad exposure on product preference. Thus, children who possessed knowledge of persuasive intent were just as persuaded by food commercials as children who lacked this knowledge. The findings of this dissertation suggest that all children are vulnerable to food marketing and that efforts to restrict advertising should address both younger and older children.

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The Role of Transportation into Narrative Worlds in Cancer Communication

Melanie C. Green, PhD

The current study focuses on "transportation into narrative worlds" as a mechanism for story-based belief change. Transportation is defined as an integrative melding of attention, imagery, and feelings, focused on story events. One purpose of the pilot project is to examine whether brief narratives (anti-smoking public service announcements/advertisements) can create transportation. Currently, a sample of smokers is rating their transportation into the ads, as well as their emotional response to the ads. We will then conduct an experimental study (in which participants will be randomly assigned to view a high or low transporting PSA) examining whether viewer transportation into an anti-smoking advertisement predicts the effectiveness of that advertisement.

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